Pre-Lab Flashcards
What do you call air trapped in the pleural cavity creating a collapsed lung?
a pneumothorax
When you have a right pneumothorax what kind of shift will you have?
a left shift of mediastinal structure
If you have a pneumothora, what happens to your IVC?
it gets kinked
If you have a left mediastinal shift due to a right pneumothorax what happens to the lung volume on the left lung?
you get reduced lung volume
A pneumothorax is in between what two layers?
the parietal pleura and visceral pleura of the lung
All together what happens when you have a right pneumothorax?
collapsed right lung, kinked IVC (reduced venous return), left shifted mediastinal structure, reduced left lung volume.
What is a survival pneumothorax, a open or tension?
Open!
When you have an open pneumothorax, why is it better than a tension pneumothorax?
An open pneumothorax allows for reduced mediastinal shift upon expiration and therefore increaesed lung volume upon expiration and increased venous return. A tension does not allow for this increased venous return
What does this describe:
Air enters pleural cavity through open, sucking chest wound. Negative pleural pressure is lost, permittin collapse of ipsilateral lung and reducing venous return to heart. Mediastinum shifts, compressing opposite lung.
Open (sucking) pneumothorax during inspiration
What does this describe:
as chest wall contracts and diaphragm rises, air is expelled from pleural cavity via wound. Mediastinum shifts to affected side and mediastinal flutter further impairs venous return by distortion of vena cave
Open (sucking) pneumothorax during expiration
what is this:
patient often cyanotic and in severe respiratory distress or in shock. Immediate closure of sucking wound imperative, preferably by petrolatum gauze pad, but if not available, by palm or anything at hand.
pneumothorax
What is this:
air enters pleural cavity through lung wound or ruptured bleb (or occasionally via penetrating chest wound) with valvelike opening. Ipsilateral lung collapses and mediastinum shifts to opposite side, compressing contralateral lung and impairing its ventilating capacity/
Tension pneumothorax during inspiration
What is this:
intrapleural pressure rises, closing valvelike opening, thus preventing escape of pleural air. Pressure is thus progressively increased with each breath. Mediastinal and tracheal shifts are augmented, diaphragm is depressed, and venous return is impaired by increased pressure and vena caval distortion.
Tension pneumothorax during expiration
Is a tension pneumothorax deadly?
yes
What is this:
Air goes in and the lung is collapsed. There is still a piece of tissue left where the rupture is and it allows for air to enter but not to leave so you get a huge build up of air and a compression of lung along with left mediastinal shift that cannot be fixed via expiration due to the flap acting as a one way valve. So during expiration it gets even worse.
How do you fix it?
Tension pneumothorax
Fix this by converting tension into open pneumothorax via a tube being inserted into the pleural cavity.
How can you determine you have a pneumothorax?
you have a shift in trachea showing a mediastinal shift, also insert a plunger and if it moves out you know air is pushing against plunger.
To fix this you shove a tube into the pleural cavity to remove air.
(blank) is inserted for emergency relief of intrathoracic pressure. Finger cot flutter valve, heimlich valve, or underwater seal should be attached.
large-bore needle
What are these sources for:
1: lung
2: intercostal vessels
3: internal thoracic (internal mammary) artery
4: thoracicoacromial artery
5: lateral thoracic artery
6: mediastinal great vessels
7: heart
8: abdominal structures (liver, spleen) via diaphragm
Hemothorax
What are the worst places for a hemothorax to originate from? Best places?
the heart, SVC, or lung tissue
thoracicoacromial artery or lateral thoracic artery
If you have a minimal hemothorax (up to 350 ml), what do you do?
you allow blood to resorb spontanteously with conservative management. Dont need a thoracentesis
If you have a moderate hemothorax ( 350 to 1500 ml) what do you do?
Thoracentesis and tube drainage with underwater-seal drainage usually suffices
If you have a massive hemothorax (over 1500 ml) what do you do?
insert 2 drainage tubes since one may clog. Early thoractomy may be necessary
For a pneumothorax where do you want to insert the tube?
2nd or 3rd interspace at midclavicular line!!!
For a hemothorax where do you want to insert the tube?
5th interspace at midaxillary line
(blank) is an accumulation of a significant amount of fluid in the pleural cavity.
hydrothorax
What may result from pleural effusions (escape of fluid into the pleural cavity)?
hydrothorax
When inserting a needle to remove fluid build up in the pleural cavity, how do you do it?
at an angle upwards so that you dont puncture the diaphragm
What is inflammation of the pleura?
pleuritis
Rough surfaces of the pleurae produce a so-called (blank)
pleural friction rub
The inflamed surfaces of the pleura may also cause the parietal and visceral layers of the pleura to adhere which is called (blank)
pleura adhesions
What are primary malignant tumors arising from the visceral and parietal pleura. Mostly an occupationally related disorder of asbestos workers.
mesothelioma of pleura
When doing a thoracentesis what are the 2 main things you must do?
go at an angle and use a lot of anesthesia
Insertion of needle into pleural cavity
thoracentesis
Which layer, the parietal or visceral layer has pain receptors?
the parietal
What do you need when you do a thoracocentesis what kind of seal do you need?
an underwater-seal drainage
When there is trauma to the thoracic wall are these simple or complicated: costovertebral dislocation (any level) Transverse rib fracture oblique rib fracture overriding rib fracture chondral fracture costochondral separation chondrosternal separation sternal fracture
simple
When there is trauma to the thoracic wall are these simple or complicated:
traumatization of pleura and of lung (pneumothorax, lung contusion, subcutaneous emphysema)
multiple rub fractures (stove-in or flail chest)
Tear of blood vessels (hemothorax)
compound by missile or puncture wound
Injury to heart or to great vessels
Complicated
What is this: fracture of several adjacent ribs in two or more places. This may be complicated by lung contusion or laceration.
flail chest
What is an indication of flail chest?
paradoxical movements during inspiration and expiration
i.e when you inspire your lung goes inward medially
What is an embolus and what can it be?
something that occludes a vessel blood clot air fat amniotic fluid foreign body mass of bacteria
Are these more common or less common sources of pulmonary embolism? external iliac vein femoral vein popiteal vein posterior tibial veins soleal plexus
Most common
Are these more common or less common sources of pulmonary embolism? right side heart gonadal veins uterine vein pelvic venous plexus lateral circumflex vein great saphenous vein small saphenous vein
less common
If there is a sudden onset of dyspnea, paleness, increase temp and tachycardia in a predisposed individual what can you suspect?
pulmonary embolism
What does an unclear costophrenic recess show?
an embolism
(blank) embolus completely occluding pulmonary arteries.
saddle embolus
What is a tumor that arises from the bronchial epithelium, tumor typically located near hilum projecting into bronchi.
bronchogenic carcinoma
What is the bifurcation point of the trachea into the two main bronchi?
carietal region
What may be designated as thoracic inlet tumor. The tumor (often a bronchogenic carcinoma) grows beyond the apex and encroaches upon important anatomical structures in the neck. Considered the WORST tumor. It grows real fast.
pancoast’s syndrome
